NORCO COMMUNITY COLLEGE
2001 Third Street
Norco, CA 92860-2600
(951) 372-7000
Instructor:
Janet Frewing
(951)372-7174
Janet.Frewing@rcc.edu
STUDENT / PROCTOR AGREEMENT FORM
Name of Course
Enrolled In
5-digit class code
Instructor's Name
__ __ __ __ __
STUDENT AGREEMENT (Please print legibly)
As a student, I agree to the following:
• To provide a stamped envelope for return of the exam, addressed to
RCC Norco Campus
2001 Third St.
Norco, CA 92860-2600
ATTN: Janet Frewing
• To be responsible to locate a proctor and to set up an appointment for each exam.
• To take the exams during the possible exam dates at a time that is convenient for the proctor.
Student Name _______________________________ID#______________________________
Email__________________________________________
Email____________________________________________
Address ________________________________________________________________
Phone (
)___________________________________
Phone (
)____________________________________
City ____________________________________________________________________
State _____________ Zip Code _____________________
By signing this form, I (the student) agree to comply with the policies and procedures of Riverside Community College and those set forth in this document.
Student Signature _________________________________________________________
Date _______________________________________
PROCTOR AGREEMENT (Please print legibly)
As a proctor, I agree to the following (Choose the one that applies):
I am a librarian, testing coordinator, administrator, or a teacher at a community college, university, elementary or secondary school.
I am a chaplain, testing administrator, or education services officer for the military.
NOTE: If proctor does not match one of the choices above, this form will be denied.
I also agree to the following:
•
I am not a current student of Riverside Community College. I am not a relative of any RCC student, nor do I live at the same address
as any RCC student.
•
I will validate the exam(s) by signing where indicated.
•
I will personally mail the completed exam(s) to the instructor at RCC Norco, immediately after the student has completed the exam(s).
•
I will do this voluntarily and will not receive any remuneration for my time or service.
Proctor Name _____________________________________________
Title __________________________________________
Institution _______________________________________________________________________________
Address (at institution) _____________________________________________________________________
City ________________________________________
State ___________
Zip Code _____________________
Email address (at the institution) _____________________________________________________________
Phone Number: Employer's (____)____________________________
Proctor's Daytime (___)_____________
To protect the security and integrity of the exams and testing process, all exams must be mailed/emailed to the institution
where the proctor is employed as an educator or military service officer.
By signing this form, I (the proctor) agree to comply with the policies and procedures of Riverside Community College and those set forth in this document.
Proctor Signature_________________________________________ Date____________________________
PLEASE KEEP A COPY FOR YOUR REFERENCE